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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: 1�i b� �t�p�,w a�,/� <br /> PID: <br /> DESCRIPTION OF WORK: �,�„9 ��, <br /> ZO.VPi TG REV�W BY: DATE APPROVED: >o-z6 •�S <br /> BUII�DING REV�W BY: DATE APPROVED: �o�z 6 �6 f' <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW � Yes _� o SEWER CONNECTION <br /> STATE SURCHARGE Yes _�No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> Z0��1G CH�CK LIST Zoning Districc: G�L-/C <br /> Fire Deparcment: Post OfFice: School Dis[rict: <br /> Lot Area: Sc.ft. S,b3� Acres •i3 Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: 3-�b-�S <br /> Proposed Setbacks: � <br /> Front (Lake): �`a Right Side: N �A <br /> Rear (Street): � (•� Left Side: 11 .7 <br /> Adjacent Structures: S� Wetland: �/%r9 <br /> Building Height: Def. Hgt. Feak Hgt. <br /> Lot Coverage: 30•3 <br /> Mo <br /> Gradina: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: /�l/✓✓� By: <br /> Zoning File: # oS-3/o3 Resolution: # Resolution Date: S-Z�'o S <br /> Shoreland District: y,�s <br /> Av�. Setback: n/i Bluff Setback: �✓/f} L,ot Covenge: 30•3 <br /> Ezistin, Proposed <br /> Hardcover: 0-75' s� �1� <br /> 75-250' ` <br /> 2�0-500' <br /> 500-1Q00' <br /> Hardcover Vaziance Required: Yes No Da[e of Council Approval: <br /> REMARKS (in house): <br /> � <br />